NPIMap

Individual provider Active NPI

Errol P. Wilder, M.D.

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1790815512
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD200582 Issued in LA
Practice address
771 Bayou Pines East Dr
Lake Charles, LA 70601-7183
Phone
(337) 433-1212
Fax
(337) 433-0736
NPI assigned
Mar 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD200582 LA Primary

Addresses

Primary practice location

771 Bayou Pines East Dr
Lake Charles, LA 70601-7183

Mailing address

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 312-8258

Other identifiers 1

IdentifierTypeStateIssuer
1073784MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070813000505 LA Practitioner - Family Practice 7214028786 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imperial Health LLPGroup PAC ID 7719886779, 75 clinicians

Practice addresses (Care Compare)

1322 Elton Rd
Suite H
Jennings, LA 70546-4100
Phone (337) 246-7200

277N Hwy 171
Suite 8
Lake Charles, LA 70611-5374
Phone (337) 312-0030

4201 Nelson Rd
Suite 100
Lake Charles, LA 70605-4117
Phone (337) 310-2273

501 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 433-8400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD200582LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health LLP CurrentSince Aug 1, 2007 Accepting new patients
Imperial Health, LLP Family Medicine CurrentSince Aug 1, 2007 Accepting new patients
Emergency Medicine Specialist, Apmc Past Accepting new patients

Locations

607 N Thomson Ave
Iowa, LA 70647
Phone (337) 582-5555

1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000

501 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8258

771 Bayou Pines East Dr
Lake Charles, LA 70601
Phone (337) 433-1212

Interoperability endpoints

  • Direct secure messaging: errol.wilder@1288.direct.myezyaccess.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1790815512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-312-8258",
            "fax_number": "337-312-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 BAYOU PINES EAST DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017183",
            "telephone_number": "337-433-1212",
            "fax_number": "337-433-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "ERROL",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD200582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073784",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.